Composition and method for treating anticholinesterase poisoning



United States Patent 3,063,901 COMPOSITION AND METHOD FOR TREATING ANTICHOLINESTERASE POISONING John F. OLeary, Bel Air, Anne M. Kunkel, Baltimore, and Aili H. Jones, North East, Md., assignors to the United States of America as represented by the Secretary of theArmy No Drawing. Filed Oct. 3, 1960, Ser. No. 60,230 4 Claims. (Cl. 167-65) (Granted under Title 35, US. Code (1952), see. 266) The invention described herein may be manufactured and used by or for the Government of the United States of America for governmental purposes without the pay-' ment to us of any royalty thereon.

This invention relates to a therapeutic mixture of a monoquaternary oxime with a bis-quarternary dioxime and atropine.

Oximes such as pyruvaldehyde aldoxime (isonitrosoacetone, MINA), 2,3-butanedione-2-oxime (DAM), 2- formyl-l-methylpyridinium chloride (or iodide) oxime (Z-PAM-Cl) 1,1'-trimethylene bis 4-formylpyridinium romide) dioxime (TMB-4), and 2-formyl l-methylpyridinium lactate oxime (2-PAML), tartnate oxime (2- PAMT), fumarate oXime (Z-PAMF), nitrate oxime (2- PAMN), hydrogen sulfate oxime (Z-PAMHS) have been reported to be effective, when given with atropine, in preventing and overcoming the toxic effects occurring in animals poisoned with inhibitors of the enzyme chlorinesterase such as: isopropyl methylphosphonofluoridate (sarin or GB), diisopropyl phosphonofluoridate (DFP), diethyl-p-nitrophenyl phosphate (paraoxon), ethyl phosphorodimethyl-amidocyanidate (tabun or GA), and tetraethyl pyrophosphate (TEPP). It has also been reported that atropine, when administered with one of the above oximes, produces a more effective result than when either one of the drugs is given alone.

We have found that atropine admixed with monoquaternary oxime and a bis-quarternary oxime increased the LD value of GB several hundred times when given intravenously 30 seconds after the GB has been administered. Such astounding results were quite unexpected.

The following tables show some of the results of our tests:

TABLE I The Intravenous LD of GB in Rabbits as Modified by Intravenous Treatment With Oximes and Atropine 30 Seconds After the GB 1 Atropine dose, 2 mg./kg. in all cases where indicated.

2 Doses of 2-PAM, TMB-4, and 2-PAML: 5 mg.lkg. Dose of DAM: 40 mgJkg. Dose of MINA: 35 mg./kg. Each given in same solution with atropine.

Table I shows the difierent treatments which were employed on the rabbit subjects, The LD is the amount "ice of GB in micrograms 'per kilogram of subject weight which was injected into the rabbits and which killed 50% of them. The column Multiples of Untreated GB LD shows the improvement over the untreated LD for example, the At+2 PAML+TMB-4 mixture gas'a result 241 times better than the untreated U3 result. The last column discloses the largest dose .of .GB which could be administered without killing any of the rabbits used. In these tests, each of the doses of Z-PA'M, 'TMB-4 and Z-PAML was 5 mg./-kg. so that the oxime mixture amounted to a total of 10 mg./ kg., whereas only 5 mg/kg. was employed when only one oxime was used. .In order to be sure that the additional amount of oxime was not responsible for the improved results, tests were made using 10 mgJkg. of only one oxime with the atropine. Results showed that a 10 mg./ kg. dose of a single oxime gave better therapy than a 5 mg./kg. dose of the same oxime but did not approach the high order of efficacy of the mixture .of the two oximes. Therefore, the improved therapy by the mixed ox-imes was not due to the 'amount of total oxime used but to some mechanism of action which follows the administration of the combination of the 2-PAM type oxime and the 'TMB-4 type oxime. It should be noted that the non-quaternary ox'imes PDAM or MINA when mixed with 2-PAM did not increase the LD In fact, DAM lowered the number of'LD 6s from 25 to 14. This shows that not :all types of oximes can be added together to get superior results. I

TABLE II Mortality Response to Subcutaneous GB in Rabbits as Influenced by Prophylactic (30 Min.) Oximes'f and Atropine Given Intramuscularly v 1 Oxime dose, each 5 mg./kg. 2 Atropine dose, 2 ing./kg., given with the oxime (s).

Table II presents data that also prove the superiority of the oxime mixture. In this instance the GB was ad ministered subcutaneously and treatment was by the intra muscular route. Treatment was given prophylactically, i.e., 30 minutes prior to poisoning with GB, The numerators stand for rabbit survivors, the denominators for total rabbits treated. The data are self-evident.

It should be noted that the specific dosage of atropine may be varied from one situation to another; for example, the dosage for a dog may be different than that for a cat in a given situation. Since atropine has been used for many years, those skilled in the art would know the correct dosage in any given situation. Furthermore, the atropine need not be administered with the oxime mixture, nor is it required to use the same route of admin istration.

3 TABLE I11 Antagonism of Neuromuscular Block Due to Intravenous GB, 220 ng./kg., in Anesthetized Cats Time after oximes for 85% Oxime, to 8 min. after initial GB dose Number recovery of of Cats 2 Twitch Respouse, Min.,

Avg.

N 3 22. 3 Z-PAML, mgJkg 2 15. 5 TMB4, 5 mgJkg 3 13. 5 2-PAMOH-TMB4OI each 5 mg./kg 3 7. 7

1 Ten times the estimated LDw in unanesthetized cats. s fEaeggeceived atropine sulfate 0.5 m n/kg. intravenously 0.5 hour e ore 6 Table III presents data which shows the elfectiveness of the oxime mixture when administered 35 to 38 minutes 1 Estimated by the method of Miller and Tainter (1944).

Atropine given by another route than oxime.

P.o.by mouth.

Table IV presents data which discloses that the oxime -mixture when administered by mouth increased the LD two fold overthe atropine treatment. However, the intramuscular administration by far produces the superior resultsp In dogs, atropine 1 mg./l g and oxime(s) were administered intravenously, 30 seconds after intravenous GA. results show that themixcd oxirnes V (2-PAMCl-i-TMB-4Cl 1:1)

are highly protective against GA at the 70 LDg level. Data on GA are presented in Table V.

TABLE V Efiicacy of Various Oximes intravenously as Atropine Adjuncts Given in Dogs 30 Seconds After the Intravenous Administration of Times the LD of GAv 1 Atropine sulfate 1 mgjkg. in each case.

We have discovered that a monoquaternary oxime-bisquaternary dioxime mixture together with atropine produces a much superior treatment for anticholinesterase poisoning than any other compound or mixture that have been tested to date.

We claim:

1. A composition for treating anticholinestcrase poisoning which consists of atropine plus an effective amount of an oxime mixture of from 30 to 70% by weight of monoquaternary oximc salt and 70 to 30% by weight of bis-quaternary dioxirne salt.

2. A method of treating animals for anticholinesterase poisoning which comprises the internal administration to the antimal of a mixture of from 70 to 30% by weight of a monoquaternary oxime and a 30 to 70% by weight of a bis-quaternary oxime, in conjunction with the stand ard atropine treatment.

3. The method of claim 2 wherein the internal administration consists of oral administration.

4. The method of claim 2 wherein the internal administration consists of an intramuscular administration.

References Cited in the file of this patent Hobbiger: Brit. J. PharmacoL, vol. 12, 1957, pages 438-446.

Poziomek: J. Org. Chem., vol. 23, pages 714717, 1958.

Bay: Federation Proceedings, March 1959, No. 1, Part I, page 366, Abstract 1445.

Drug Trade News, 34:3, February 9, 1959, pages 41 and 71.

Willis: Pharm. of Anticholinesterases, C.W.L. 2-14, pages 1620, September ll, 1959. 

1. A COMPOSITION FOR TREATING ANTICHOLINESTERASE POISONING WHICH CONSISTS OF ATROPINE PLUS AN EFFECTIVE AMOUNT OF AN OXIME MIXTURE OF FROM 30 TO 70% BY WEIGHT OF MONOQUATERNARY OXIME SALT AND 70 TO 30% BY WEIGHT OF BIS-QUATERNARY DIOXIME SALT. 